237例肺癌外科治疗影响预后因素的分析

An Analysis on Prognostic Influencing Factors in 237C ases of Postoperative Lung Cancer

目的:分析TNM分期、病理类型、年龄和手术方式与预后的关系,探讨在各影响预后因素中外科治疗手段的正确选择。方法:应用SPSS8.0统计软件,对237例肺癌患者资料建立数据库并进行统计分析,用寿命表法进行生存率分析。两组间生存率差异显著性检验用Logrank方法。结果:Ⅱb期以上肺癌总的5年生存率为49.8%,Ⅲa期仅为13.1%(P<0.01),Ⅲb和Ⅳ期肺癌均为0%,但伴颅内单发转移病灶手术治疗后平均生存期19个月。鳞癌5年生存率48.3%,腺癌和腺鳞癌分别为30.5%和13.3%(P<0.05和<0.01);小细胞肺癌为0;大细胞肺癌为60.2%。70岁以下肺癌患者肺楔形切除术5年生存率为0;肺叶切除术31.4%(P<0.01);全肺切除术18.2%(P<0.01);肺叶加支气管袖状切除术37.6%(P<0.01)。70岁以上肺癌患者肺楔形切除5年生存率33.4%,肺叶切除27.0%(P<0.05);全肺切除和肺叶加支气管袖状切除术3年生存率分别为20.2%和50.5%(P<0.01)。结论:Ⅱb期以上肺癌外科治疗应为首选;Ⅲa期应采用术前新辅助治疗的综合治疗;手术可作为Ⅲb和Ⅳ期肺癌姑息性治疗的手段;脑部单个转移病灶的肺癌不应为手术禁忌证。腺癌和腺鳞癌应以手术为主的综合性治疗;小细胞肺癌应以化疗为主的综合性治疗;透明细胞类型的大细胞肺癌应以手术为主的综合性治疗。70岁以下肺癌患者肺叶切除加?

Objective:To study the correlation of prognostic influencing factors:97-pTNM stage,pathologic type,age and operative modality to the prognosis of lung cancer patients and to explore the optimal operative modality.Methods:Two hundred thirty-seven patients underwent op-erations for lung cancer were analysed statistically using SPSS8.0software.The survival rate was analysed with life table method.Comparison of the difference of survival rates between groups was made according to the log-rank test.Results:The overall5-year survival rate ofⅡb stage pa-tients was49.8%,that ofⅢa stage13.1%and those ofⅢb andⅣ0,but the postoperative mean survival time was19months in the single brain metastasis patients.The5-year survival rates of the patients with squamous carcinoma,adenocarcinoma,adenosquamous carcinoma,small cell carcinoma and large cell carcinoma were48.3%,30.5%,13.3%,0and60.3%respectively.The5-year survival rates of the patients under70years old who underwent different modality operations were as follows:Those of wedge resection,lobectomy,total peumonectomy and sleeve resection were0,31.4%,18.2%and37.9%respectively.The5-year survival rates of the patients over70years old who underwent wedge resection and lobectomy were33.4%and27.0%respec-tively(P>0.05).The3-year survival rates of the patients who received total peumonectomy and sleeve resection were20.2%and50.5%respectively(P<0.01).Con clusion:Surgical treatment is the first selection for above IIb stage patient.TheⅢa stage patient should receive the combined therapy with preoperative neo-adjuvant chemotherapy.ForⅢb andⅣstage patients palliative therapy can be given.Operation is not absolutely contraindicated in patients with sin gle brain metastasis.Adenocarcinoma,adenosquamous carcinoma and large cell cancer of hya line cell type can be treated with combined therapy mainly on operation.Small cell lung cancer should be treated with combined therapy maily on chemotherapy.The patients under70years old can be treated with lobectomy with clearance of regional lymph nodes,and for patients over70years old,minimal traumatic operation can be used.